The Role of Vitamin D in the Pathogenesis of Adolescent Idiopathic Scoliosis
SOURCE: Asian Spine J. 2018 (Oct 16) [Epub]
Shu-Yan Ng, Josette Bettany-Saltikov, Irene Yuen Kwan Cheung, Karen Kar Yin Chan
Institute of Health and Social Care,
Several theories have been proposed to explain the etiology of adolescent idiopathic scoliosis (AIS) until present. However, limited data are available regarding the impact of vitamin D insufficiency or deficiency on scoliosis. Previous studies have shown that vitamin D deficiency and insufficiency are prevalent in adolescents, including AIS patients. A series of studies conducted in Hong Kong have shown that as many as 30% of these patients have osteopenia. The 25-hydroxyvitamin D3 level has been found to positively correlate with bone mineral density (BMD) in healthy adolescents and negatively with Cobb angle in AIS patients; therefore, vitamin D deficiency is believed to play a role in AIS pathogenesis. This study attempts to review the relevant literature on AIS etiology to examine the association of vitamin D and various current theories. Our review suggested that vitamin D deficiency is associated with several current etiological theories of AIS. We postulate that vitamin D deficiency and/or insufficiency affects AIS development by its effect on the regulation of fibrosis, postural control, and BMD. Subclinical deficiency of vitamin K2, a fat-soluble vitamin, is also prevalent in adolescents; therefore, it is possible that the high prevalence of vitamin D deficiency is related to decreased fat intake. Further studies are required to elucidate the possible role of vitamin D in the pathogenesis and clinical management of AIS.
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KEYWORDS: Bone density; Scoliosis; Vitamin D; Vitamin K
From the Full-Text Article:
Adolescent idiopathic scoliosis (AIS) affects 0.47%–11.1% of the general population.  As the name suggests, the cause of the condition remains unclear. Several theories have been proposed, including genetic, neuro-developmental abnormalities, motor control and motor-sensory integration dysfunctions, vestibular and proprioceptive disorders, biomechanical growth modulation, uncoupled spinal neuro-osseous growth, thoracospinal concept, systemic and metabolic disorders , and decreased bone density (Table 1). [3–5]
Recently, Schlösser et al.  in 2014 performed a structured review of the literature regarding all the proposed and diverse etiologies proposed for the causes of AIS. They found that of all the theories, only those related to impaired gait control and decreased bone mineral density (BMD) had a moderate strength of evidence (Table 2). Other theories, including those of different volume of the cerebellar regions, asymmetric somatosensory evoked potentials, reduced trunk strength, decreased body weight, increased breast asymmetry, and impaired bone quality were only supported by weak evidence. 
Considering that vitamin D may reportedly play a role in the cerebral process of postural balance  and that serum vitamin D level is positively correlated with the BMD of the hip [8, 9] and negatively with the Cobb angle , vitamin D insufficiency or deficiency is speculated to influence AIS etiopathogenesis (Table 3).
In this study, we attempted to determine whether there is an association between vitamin D and the different current and relevant theories regarding AIS. We also assessed the impact of vitamin D deficiency or insufficiency on AIS development